Fearful Healers: A Special Report.; Risk of Contracting AIDS Virus Is Changing Practices in Medicine

By ELISABETH ROSENTHAL

Published: November 11, 1990

Preparing for surgery, Dr. William Schecter donned his scrub suit and a surgical cap and headed to the operating room, as he had for 18 years.

But these days he continues dressing once he is there: rubber boots, a full-length waterproof apron, two pairs of gloves, water-resistant sleeve protectors and eye goggles. For particularly bloody cases, he substitutes a helmet with a wraparound face shield, new surgical armor for the age of AIDS.

"I can't count how many times my arms were covered with blood before 1987 and or how many pairs of shoes and socks I soaked and ruined," said Dr. Schecter, a trauma surgeon at San Francisco General Hospital. "Clearly that's not acceptable any more. If you have a pimple or a cut you could catch the virus."

"Am I scared?" he said with a self-mocking laugh, "Naw. I'm a surgeon. But am I concerned? I'd have to be an idiot to say no." Unspoken Fears of Risk

Ever since 1987, when the Federal Centers for Disease Control started reporting a trickle of cases of health care workers who had contracted the AIDS virus through occupational exposure, doctors and nurses have been grappling with often unspoken fears about personal risk and how they should affect the treatment of patients.

As these fears lie buried and festering, experts worry that they contribute to discrimination against patients who harbor the virus. "My hunch is there certainly is an impact," said Dr. Douglas Owens of Stanford University Medical Center, who is studying doctors' risks and fears. "I'm concerned that people are not getting cared for as a result of these perceptions."

The effects may be both subtle and pervasive. For patients infected with the AIDS virus, surgeons drag their feet in scheduling operations, exchanging aggressive treatment for a wait-and-see approach, said Dr. Abigail Zuger, who treats many AIDS patients at Montefiore Medical Center in the Bronx.

In a survey of 60 people infected with the AIDS virus done by the New York City Human Rights Commission two years ago, 68 percent complained of excessive delays in obtaining treatment. Suspicious of Small Count

Although the disease-control centers' count of workers infected on the job stands at 37, many doctors are suspicious that the centers have played down the risk. They say that many people infected on the job, probably hundreds, remain untallied. "I can name 10 people offhand," said Dr. Mark S. Litwin, a surgeon in training at Harvard's Brigham and Women's Hospital who has spoken at medical meetings about the issue.

The disease-control centers have advised health workers to use precautions like latex gloves to avoid all contact with patients' blood. But even double layers of gloves cannot prevent all cuts and needle sticks. Dr. Litwin said at least six residents where he works are taking six-week treatments with the drug AZT after needle sticks in hopes of preventing infection, even though studies have thus far failed to demonstrate that this works.

In a study published in The Journal of the American Medical Association in September, 21 percent of a sample of medical students at Cornell University Medical College said they had been pricked by a needle used on a patient suspected of carrying the AIDS virus in the previous year.

The risk of catching the disease from a tainted needle is estimated at 1 in 250, which the disease-control centers calls low. But it is at least as high as some experts have estimated the risk of having anal intercourse with a person infected with the AIDS virus, which is generally considered high-risk behavior.

"As a statistic that sounds O.K., but if you get the needle stick that sounds pretty high," said Loretta Sullivan a nurse practitioner at Montefiore. The virus is transmitted through blood-to-blood contact as well as through sexual contact. In a Very Bad Year, Several Punctures

In surgical fields, a doctor or a nurse might sustain a half-dozen needle punctures in a bad year, but their exposure to the AIDS virus would depend on the rate of infection where they practiced. Although health workers have a greater chance of getting tuberculosis or hepatitis on the job than AIDS, the deadliness of the infection renders acquired immune deficency syndrome an object of peculiar fear.

"I don't like to participate in AIDS cases if I can avoid it," said one surgical resident who spoke on the condition of anonymity. "It is a terrible disease and you know sooner or later you're going to get stuck."

Public health experts say that such attitudes bubble to the surface when doctors think they might be at risk. "You send a patient to a gastroenterologist for a liver biopsy which you know he needs," said Dr. Zuger, and instead of the specialist's doing the procedure, he stalls, sending back a note saying he will consider a biopsy in six months. "The reluctance can be very frustrating," she said.

A study by Dr. Molly Cooke at the University of California at San Francisco found that 36 percent of residents training in general medicine did not intend to have patients infected with the human immunodeficiency virus that causes AIDS. Other research has suggested that medical students are turning down training positions in cities with serious AIDS problems. As the number of HIV-infected patients grows, such findings have fueled fears that there will not be enough doctors to go around in these cities.